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COTY BOURQUE LCSW
NPI 1356850960
Social Worker - Clinical in Vicksburg, MS

Active since September 26, 2017PECOS EnrolledAccepts Medicare Assignment
1911 MISSION 66 STE B, VICKSBURG, MS 39180(337) 519-7797 Get Directions Write a Review

NPPES record last updated: May 13, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 13, 2025, Nov 14, 2022, Jul 13, 2021 (3 updates tracked since 2021).

About Coty Bourque Lcsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COTY BOURQUE LCSW (NPI 1356850960) is an individual clinical provider in Vicksburg, Mississippi and active in the NPI registry since September 2017. He is enrolled in Medicare PECOS and is a graduate of Other (2020).

NPPES Registry Identity

NPI1356850960
Entity TypeIndividualMale
Primary Taxonomy1041C0700X
Provider Legal NameCOTY BOURQUECredential: LCSW
Location Address1911 MISSION 66 STE BVicksburg, MS 39180-3762
Mailing Address1413 Willow StNew Iberia, LA 70560-1066 · (337) 519-7797
Phone(337) 519-7797
Sole ProprietorNo
Medical School CMSOtherGraduated 2020
Enumeration DateSeptember 26, 2017
Last NPPES UpdateMay 13, 20253 updates tracked since enumeration
NPPES CertifiedMay 13, 2025
✔ NPI 1356850960 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X
1911 MISSION 66 STE B, Vicksburg, MS 39180
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Coty Bourque Lcsw is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1557739745
PECOS Enrollment IDI20221118001570
Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 39180 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$0.00 typical visit price
range $51.65 – $159.18
Typical copayment $0.00 (range $12.91 – $39.79)
Most-billed visit code NA
Established Patient
$64.96 typical visit price
range $16.15 – $129.61
Typical copayment $16.24 (range $4.03 – $32.40)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KAYLA MORIARTY LCSW
Social Worker (Clinical)
1911 MISSION 66 STE B
VICKSBURG, MS 39180
Warren County (601) 665-4162
ANNA ADCOCK LCSW
Social Worker (Clinical)
1911 MISSION 66 STE B
VICKSBURG, MS 39180
Warren County (601) 665-4162
KATHLEEN CHAPPELEAR LCSW
Social Worker (Clinical)
1911 MISSION 66 STE B
VICKSBURG, MS 39180
Warren County (601) 665-4162
JENIFER JUSTICE CRNP
Nurse Practitioner (Family)
1911 MISSION 66 STE B
VICKSBURG, MS 39180
Warren County (014) 562-5986
BONNY SAUCIER CFNP
Nurse Practitioner
1911 MISSION 66 STE B
VICKSBURG, MS 39180
Warren County (601) 456-2598
ROXANE THERESA MONCURE AGNP
Nurse Practitioner (Gerontology)
1911 MISSION 66 STE B
VICKSBURG, MS 39180
Warren County (601) 456-2598
ANGELA JONES FNP
Nurse Practitioner (Family)
1911 MISSION 66 STE B
VICKSBURG, MS 39180
Warren County (601) 456-2598
LAKEITHA HAMBERLIN TURNER FNP-BC
Nurse Practitioner (Family)
1911 MISSION 66 STE B
VICKSBURG, MS 39180
Warren County (601) 456-2598

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Coty Bourque's NPI number?

The NPI number for Coty Bourque is 1356850960. It was assigned to this individual provider in the NPPES registry on September 26, 2017.

Where is Coty Bourque located?

Coty Bourque practices at 1911 Mission 66 Ste B, Vicksburg, MS 39180. The listed phone number is (337) 519-7797.

What is Coty Bourque's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Coty Bourque enrolled in Medicare?

Yes. Coty Bourque is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Coty Bourque was last updated on May 13, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.